AVNRT in Haemodynamically Stable Patients When Adenosine Has Failed
This protocol covers the next clinical step for haemodynamically stable atrioventricular nodal re-entrant tachycardia that has not terminated after an initial adenosine bolus.
Previous step — escalation trigger
First-line management used adenosine (intravenous bolus), targeting termination of the tachycardia. When adenosine does not achieve termination, this second-line protocol is indicated.
Clinical scenario
The patient remains haemodynamically stable — no haemodynamic instability is present. The clinical goal is conversion or control of the atrioventricular nodal re-entrant tachycardia.
Second-line approach (partial — full regimen available below)
Intravenous pharmacological therapy is the next step, with agent selection informed by the patient’s haemodynamic status and comorbidities.
The full protocol specifies which agents to use, contraindication checks, and the complete decision sequence.
References
DOI: 10.1093/eurheartj/ehz467
- Haemodynamically stable patients
- Verapamil or diltiazem i.v. should be considered if vagal manoeuvres and adenosine fail.
- Beta-blockers (i.v. esmolol or metoprolol) should be considered if vagal manoeuvres and adenosine fail.
- i.v. verapamil and diltiazem are contraindicated in the presence of hypotension or HFrEF.
- i.v. beta-blockers are contraindicated in the presence of decompensated heart failure.
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